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Are women and girls more vulnerable to tuberculosis and malaria?

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woman at clinicA woman visits a tuberculosis clinic in Iraq. Photo: Safin Hamed/UNDP

Are tuberculosis (TB) and malaria still a widespread threat? Popular belief says no. But, in fact, they are still grave health challenges that need more attention, especially in how they are affected by gender.

The World Health Organization recently reported that TB now ranks alongside HIV as the leading cause of death from infectious disease. And the disease has a disproportionate effect on women.

Today, TB kills more women globally than any other single infectious disease, and more women die annually from TB than from all causes of maternal mortality combined. Some TB symptoms can also affect men and women in profoundly different ways.  For example, women have a higher prevalence of genital TB, which is difficult to diagnose and has been identified as an important cause of infertility in settings with high TB incidence.

Similarly, malaria caused around 438,000 deaths in 2015, the majority of which occurred in sub-Saharan Africa. Women, particularly pregnant women, and children are at the greatest risk of contracting. Additionally, once malaria affects a family, the economic effect is greater for female family members, who face increased pressures to provide food and medicines, as well as increase care-giving responsibilities.

What are the factors that contribute to the gender differences we see regarding TB and malaria susceptibility and impact, as well as the differences between men and women in if, when and how they access health care services?

Some of these gendered vulnerabilities and effects of the two diseases are due to biological factors. For example, extra-pulmonary TB has been found to have adverse outcomes for pregnancy, including increased antenatal hospitalization and neonatal complications. Similarly, pregnant women are more vulnerable to malaria, making them at risk of severe anemia and death. This vulnerability is heightened for young, poor, and rural women and women living with HIV, who for example are especially vulnerable to malaria of the placenta because they have not yet developed the immunity that comes with multiple pregnancies.

However, very often the differences between vulnerabilities and access to preventative measures and treatment services are determined by the social, economic and cultural circumstances in which men and women live. For example, because poor women cannot afford treatment, they are more likely than men to rely on ineffective traditional remedies. For example, in Ghana, studies have found that women’s household responsibilities, including cooking the evening meal outdoors or waking up early to prepare the household may put them at greater risk of mosquito bites than men.

Similarly, the burden of TB stigma falls more heavily on women than men. In Viet Nam, a woman found to have TB may be divorced by her husband or, if unmarried, may have difficulty in finding a husband. Inadequate or gender-insensitive health care infrastructure has also been found to reduce women’s access to TB. For example, a study in Pakistan reported that women felt uncomfortable producing the mucus needed for the standard diagnostic test for TB, due to gender norms about public behavior.

Much more remains to be done to address the complexity of factors that drive women and girls’ vulnerability to TB and malaria. More focus is needed on the links between gender norms, the diseases’ burdens, and the needs and rights of key populations that are especially vulnerable to each disease.

The 2030 Development Agenda challenges us to do better, and governments have committed to several goals related to gender equality and health, including specific targets to eradicate TB and malaria and on other non-communicable diseases.

Caitlin Boyce Blog post HIV and health Global fund Gender equality Women's empowerment Agenda 2030 Health Sustainable development